Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes.
Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes.
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DOI：
10.15256/joc.2016.6.76
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发表时间：
2016-01-01
影响因子：
--
通讯作者：
Anderson, Gerard F
中科院分区：
文献类型：
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作者：
DuGoff, Eva H;Bandeen-Roche, Karen;Anderson, Gerard F
背景：护理的连续性是初级保健实践的基本租户。然而，对于复杂条件下的老年人，护理连续性的重要性的证据是混合的。目的：评估护理连续性的测量、慢性病的数量和健康结果之间的关系。设计：我们分析了来自一个队列的数据，2010年7月至2011年12月期间，600名患有糖尿病和≥1种其他慢性疾病的美国老年人参加了私人医疗保险健康计划。多变量回归模型被用来检查基线连续性的相关性结果：在调整基线协变量后，高已知提供者连续性（KPC）与84%的（调整的比值比0.16; 95%置信区间0.09-0.26）复合结局风险降低。在患有≥6种疾病的个体中，高KPC与复合结局风险降低显著相关。然而，通常提供者的护理和连续性的护理指数并没有显着相关的复合结果在整体样本或在那些≥6 conditions.CONCLUSION：护理的连续性和不良后果之间的关系取决于措施的连续性护理雇用。高发病率患者更有可能受益于由KPC衡量的护理干预措施的连续性，KPC衡量的是随着时间的推移，同一提供者的患者就诊比例。
BACKGROUND: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed.OBJECTIVE: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes.DESIGN: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. Multivariate regression models were used to examine the association of baseline continuity (the first 6 months) and the composite outcome of any emergency room use or inpatient hospitalization occurring in the following 12-month period.RESULTS: After adjusting for baseline covariates, high known provider continuity (KPC) was associated with an 84% (adjusted odds ratio 0.16; 95% confidence interval 0.09-0.26) reduction in the risk of the composite outcome. High KPC was significantly associated with a lower risk of the composite outcome among individuals with ≥6 conditions. However, the usual provider of care and continuity of care indices were not significantly related with the composite outcome in the overall sample or in those with ≥6 conditions.CONCLUSION: The relationship between continuity of care and adverse outcomes depends on the measure of continuity of care employed. High morbidity patients are more likely to benefit from continuity of care interventions as measured by the KPC, which measures the proportion of a patient's visits that are with the same providers over time.